Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid cancer,accounting for 90%.Most cases of PTC are inert tumors,while a few are invasive.Cervical lymph node metastasis is one of the major manifestations of invasive PTC.Preoperative accurate prediction of cervical lymph node metastasis is of great significance for the selection of therapeutic regimen and the evaluation of prognosis.New ultrasound technology is a non-invasive,convenient,and radiation-free examination method,playing a key role in predicting the cervical lymph node metastasis of PTC.This paper reviews the research status and makes an outlook on new ultrasound technology in predicting cervical lymph node metastasis of PTC.
Humans ; Thyroid Cancer, Papillary/diagnostic imaging* ; Lymphatic Metastasis/diagnostic imaging* ; Carcinoma, Papillary/diagnostic imaging* ; Thyroid Neoplasms/diagnostic imaging* ; Technology

OBJECTIVETo compare the size of papillary thyroid carcinoma on ultrasonography(US)and the actual size measured during histological examination and to discuss the potential causes of such discrepancy.

METHODSA total of 148 patients with histologically confirmed papillary thyroid carcinoma underwent thyroid surgery in our center from December 2012 to May 2013. Patients were stratified based on the size,morphology,margin,cystic component,and presence of Hashimoto's disease to compare the discrepancy of the US and pathalogical measurements.

RESULTSThe mean sizes of the nodules measured by US and pathology were(1.58±0.94)cm and(1.33±0.84)cm,respectively(P=0.000). In 70.9%(105/148)of the nodules,the sizes measured by US were larger than those measured by pathology. In 17.6%(26/148)of the nodules,the sizes measured by US were smaller than those measured by pathology. In 1.1-1.4 cm size subgroup,the difference between mean ultrasound diameter and pathologic diameter was not significant [(1.21±0.11)cm vs.(1.11±0.32)cm,P=0.062]. In 0.1-1.0 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(0.75±0.19)cm and(0.62±0.23)cm,respectively(P=0.000). In ≥1.5 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(2.48±0.70)cm and(2.03±0.81)cm(P=0.000).

CONCLUSIONSThere is a significant discrepancy between US and pathologic size measurements for papillary thyroid carcinoma. However,for nodules sized 1.1-1.4 cm,the ultrasound and pathologic measurements are more likely to be consistent.

Carcinoma ; diagnostic imaging ; pathology ; Carcinoma, Papillary ; Hashimoto Disease ; Humans ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; Ultrasonography

Objective: To analyze the features of degenerating cystic thyroid nodules (DCTN) on conventional ultrasound and contrast-enhanced ultrasound (CEUS), and to explore the differentiation between DCTN and papillary thyroid carcinomas (PTC). Methods: A total of 46 DCTN (39 cases, including 12 males and 27 females, with an age range of 25 to 76 years) and 36 PTC (32 cases, including 8 males and 24 females, with an age range of 23 to 68 years) diagnosed via fine- needle aspiration (FNA) or surgery from February 2019 to January 2020 in the First Affiliated Hospital of Nanchang University were enrolled. The size, shape, margin, echogenicity, presence of shadowing, calcification and vascularity of DCTN and PTC were retrospectively evaluated, and 28 DCTN and 30 PTC underwent CEUS were separately analyzed and compared.The t test, χ² test or Fisher's exact test were implemented to compare the features of ultrasound among the two groups. The binary Logistic regression test was performed to determine whether the feature whose difference was statistically significant was an independent predictive risk factor. Results: A univariate analysis indicated that DCTN more frequently showed wider-than-tall shapes, marked hypoechogenicity, well-defined margin and no or dot-lined enhancement (wider-than-tall shapes: 36 vs. 17, χ²=8.511; well-defined margin: 30 vs. 15, χ²=4.523; marked hypoechogenicity: 27 vs. 9, χ²=9.310; no or dot-lined enhancement: 24 vs. 3, χ²=33.369; all P＜0.05). A multivariate analysis demonstrated that wider-than-tall shapes, well-defined margin and marked hypoechogenicity were independent predictors for DCTN (OR values were 5.204, 3.134 and 5.042, P values were 0.003, 0.031, and 0.003, respectively). Among 28 DCTN, 15 showed a decrease in mean maximum diameter (24.3±11.4 mm) with a mean time span of (18.6±10.5) months between the presence and absence of suspicious ultrasound features. Conclusions: Compared with PTC, DCTN shows the ultrasound characteristics of wider-than-tall shapes, well-defined margin, marked hypoechogenicity and no or dot-lined enhancement pattern. Ultrasound follow-up can help to identify spontaneous DCTN.
Adult ; Aged ; Carcinoma, Papillary/diagnostic imaging* ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Cancer, Papillary/diagnostic imaging* ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Nodule/diagnostic imaging* ; Ultrasonography

Carcinoma, Papillary/diagnostic imaging* ; Humans ; Retrospective Studies ; Thyroid Cancer, Papillary/diagnostic imaging* ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Nodule/diagnostic imaging* ; Ultrasonography

OBJECTIVE: The purpose of this article is to discuss the clinical value of central neck lymph node dissection in papillary thyroid carcinoma, especially in thyroid papillary microcarcinoma (PTMC). Also this article wants to evaluate the diagnostic significance of preoperative ultrasonography of central neck metastasis lymph nodes and the clinical significance of preoperative ultrasonography in central neck lymph node dissection. METHOD: Collected and analyzed 121 cases from September 2012 to December 2013. All of them had done the central neck lymph node dissection with the same standard by the same surgeon in our department. Evaluate the value of preoperative ultrasound diagnostic in thyroid microcarcinoma and non-microcarcinoma. RESULT: In the 121 patients, The 62 patients were diagnosed with PTMC (primary lesion d≤1. 0 cm). Accuracy rate of ultrasound diagnostic was 74. 2% (46/62), the rate of missed diagnosis was 61. 9% (13/21), the rate of misdiagnosis was 7. 3 % (3/41), sensitivity was 38. 1% (8/21), specificity was 92.7% (38/41), positive predictive value was 72. 7% (8/11), negative predictive value was 74. 5% (38/51) and the value of Kappa was 0. 3485. The other 59 patients was diagnosed with thyroid papillary non-microcarcinoma (primary lesion d>1. 0 cm). The accuracy rate was 55. 9% (33/ 59), the rate of missed diagnosis was 58. 3% (21/36), the rate of misdiagnosis was 21. 7% (5/23), sensitivity was 41. 7% (15/36), specificity was 78. 3% (18/23), positive predictive value was 75. 0% (15/20), negative predictive value was 46. 2% (18/39) and the value of Kappa was 0. 1757. CONCLUSION Cervical central lymph node dissection was necessary when the ultrasound diagnosis of cervical central lymph node-positive was prompted suspiciously in the thyroid papillary microcarcinoma. However, when it prompted negative, we could recommend patients to do the prophylactic central lymph node dissection in conjunction with the risk factors. Whether the ultrasound diagnosis of central lymph node was prompted suspiciously or not in the thyroid papillary microcarcinoma and non-microcarcinoma, the central lymph nodes dissection is necessary.
Carcinoma ; diagnostic imaging ; Carcinoma, Papillary ; diagnostic imaging ; Diagnostic Errors ; Humans ; Lymph Node Excision ; Lymph Nodes ; diagnostic imaging ; Lymphatic Metastasis ; diagnostic imaging ; Neck ; Risk Factors ; Sensitivity and Specificity ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; diagnostic imaging ; Ultrasonography

OBJECTIVETo explore the difference of the ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma.

METHODSThe ultrasound data of 7 patients with histopathologically confirmed anaplastic thyroid carcinomas who were treated in PUMC Hospital from April 2001 to June 2014 were retrospectively studied. In addition, 21 sex-and age-matched patients with histopathologically confirmed papillary thyroid carcinomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard. The ultrasonic features of anaplastic thyroid carcinoma and papillary thyroid carcinoma were analyzed and compared.

RESULTSPatients with anaplastic thyroid carcinoma were predominantly females (5/7,71.4%), with an average age of (64.9 ± 11.3) years. Large mass [(5.17 ± 1.26) cm vs. (1.85 ± 1.89)cm, P<0.001], anteroposterior-to-transverse diameter ratio less than 1(100.0% vs. 47.6%, P ＝ 0.03), and punctuate calcification (100.0% vs. 52.4%, P ＝ 0.03) were more frequently associated with anaplastic thyroid carcinoma than with papillary thyroid carcinoma. No significant difference was observed between the two groups in the shape, margin, cystic change, echogenicity, echotexture,vascularity,and envelope (all P>0.05).

CONCLUSIONIn elderly women with common malignant features on ultrasound, the thyroid nodules with a maximum diameter greater than 5 cm,anteroposterior-to-transverse diameter ratio less than 1,and microcalcifications are highly likely to be anaplastic thyroid carcinoma.

Carcinoma ; diagnostic imaging ; Carcinoma, Papillary ; Female ; Humans ; Male ; Middle Aged ; Thyroid Carcinoma, Anaplastic ; diagnostic imaging ; Thyroid Neoplasms ; diagnostic imaging ; Thyroid Nodule ; Ultrasonography

OBJECTIVETo explore the possibility of predicting the histopathological types of small renal cell carcinoma (RCC) by analyzing the different ways of enhancement with multiphasic multidetector computed tomography (MDCT) of small renal cell carcinomas (diameter≤4 cm).

METHODSCT images of 93 cases, diagnosed as RCC by pathology, were analyzed retrospectively, including 70 clear cell renal cell carcinoma (CCRCC), 13 papillary renal cell carcinoma (PRCC) and 10 chromophobe renal cell carcinoma (CRCC). All of the cases were examined by multiphasic multidetector CT scanning.

RESULTSIn plain scans, 46 CCRCCs were homogeneous, 21 CCRCCs were heterogeneous with low-density area and 3 of them had calcification. CCRCCs were enhanced in contrast scan with a presence of "wash in and wash out" enhancement in general. 11 PRCCs were homogeneous and 2 PRCCs had calcification. Slight-homogeneous enhancement and "delayed enhancement" were present in the PRCCs. Six CRCCs were homogeneous and 2 were calcified, 2 CRCCs were heterogeneous with low-density area. The CRCCs presented as slight or moderate enhancement and 5 CRCCs as homogeneous enhancement, while one CRCC was "spoke-wheel-like enhancement", with a trend of "delayed enhancement". Statistically significant differences were revealed among the actual enhanced CT values, the ratio of enhanced CT value to aorta CT value in the corticomedullary phase, nephrographic phase and excretory phase between the CCRCCs and non-CCRCCs (P<0.001). The analysis of receiver operating characteristic curves (ROC) revealed that when the actual enhanced CT value of tumors in CMP larger than 84.2 HU, the ratio of actual enhanced CT value to aorta CT value at the same phase in CMP larger than 0.315 were used as criteria to diagnose CCRCCs and excluded non-CCRCCs, the diagnostic value was best.

CONCLUSIONSMDCT is of an important significance in the diagnosis and differential diagnosis of small CCRCCs and non-CCRCCs.

Calcinosis ; diagnostic imaging ; Carcinoma, Papillary ; diagnostic imaging ; Carcinoma, Renal Cell ; diagnostic imaging ; Carcinoma, Small Cell ; diagnostic imaging ; Contrast Media ; Diagnosis, Differential ; Humans ; Kidney Neoplasms ; diagnostic imaging ; Multidetector Computed Tomography ; ROC Curve ; Retrospective Studies

OBJECTIVETo investigate the feasibility of differentiation of lymphoma, metastatic lymph nodes of squamous cell carcinoma (SCC) and papillary thyroid carcinoma (PTC) in the head and neck by single-source dual-energy spectral CT.

METHODS25 cases of non-Hodgkin lymphoma (NHL) with 236 lymph nodes, 3 cases of Hodgkin's lymphoma (HL) with 32 lymph nodes, 21 cases of SCC with 86 lymph nodes and 19 cases of PTC with 92 lymph nodes were evaluated by enhanced GSI. CT attenuation of lymph nodes in the monochromatic images at different keV levels and the iodine and water contents of these lymph nodes were measured. The slope of spectral curve was calculated using CT value at 40 keVand 90 keV. All results were analyzed with ANOVA and t test.

RESULTS70 keV had the best single energy images. Normalized Hounsfield unit (NHU) of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), T lymphoblastic lymphoma (T-LBL), HL, PTC and SCC was 0.32 ± 0.10, 0.46 ± 0.08, 0.41 ± 0.11, 0.41 ± 0.11, 0.56 ± 0.15 and 0.34 ± 0.16, respectively. Normalized iodine concentration (NIC) of them was 0.20 ± 0.08, 0.32 ± 0.08, 0.25 ± 0.09, 0.30 ± 0.12, 0.49 ± 0.18 and 0.23 ± 0.18, respectively. The slope of spectral curve (k) of them was -1.92 ± 0.55, -2.45 ± 0.60, -1.82 ± 0.57, -2.57 ± 0.54, -5.44 ± 2.41 and -1.97 ± 0.81, respectively. Compared with the NHU, there was a statistically significant difference in each pair except DLBCL and SCC, and T-LBL and HL. Compared with the NIC, there was a statistically significant difference in each pair except DLBCL and SCC, FL and HL, T-LBL and SCC, and T-LBL and HL. Compared with the slope of spectral curve, there was statistically significant difference in each pair except DLBCL and T-LBL, DLBCL and SCC, FL and HL, and T-LBL and SCC.

CONCLUSIONSMalignant lymph nodes of different types of diseases have certain different values of quantitative parameters in spectral CT imaging. By using CT attenuation, the shape and slope of spectral curve and the iodine content, single-source dual-energy CT may potentially provide a quantitative analysis tool for the diagnosis and differential diagnosis of lymph node alterations.

Carcinoma ; diagnostic imaging ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; diagnostic imaging ; Diagnosis, Differential ; Head and Neck Neoplasms ; diagnostic imaging ; Hodgkin Disease ; diagnostic imaging ; Humans ; Lymph Nodes ; diagnostic imaging ; Lymphoma ; diagnostic imaging ; Lymphoma, Follicular ; diagnostic imaging ; Lymphoma, Large B-Cell, Diffuse ; diagnostic imaging ; Lymphoma, Non-Hodgkin ; diagnostic imaging ; Neck ; Thyroid Neoplasms ; diagnostic imaging ; Tomography, X-Ray Computed

BACKGROUNDThe incidence of thyroid cancer has been increasing. Our aim was to evaluate the efficacy of low-dose dual-phase helical computed tomography (CT) in the characterization of thyroid lesions, and to discuss the relationship between image characteristics and their pathology.

METHODSOne hundred and six patients with thyroid lesions underwent low-dose dual-phase helical CT after the injection of contrast material. CT scans were obtained at arterial and venous phase with delays of 25 and 65 seconds, and tube current of 60 and 120 mA, respectively. The attenuation change in the lesion between the arterial and venous phase was analyzed and categorized as "increased," "decreased," "mixed" or "no change."

RESULTSHistopathologic diagnosis was obtained by surgery in 106 patients (115 lesions). Of the 106 patients, 45 had nodular goiter, 5 thyroid adenoma, 6 thyroiditis, and 50 papillary thyroid carcinoma (PTC) (59 lesions). The attenuation value showed a significant difference (P < 0.05) between the arterial and venous phase for the high attenuation area. There was statistical significant difference in terms of attenuation value in high attenuation areas at both phases and in low attenuation areas on arterial phase between nodular goiter and PTC (P < 0.05). However, there was no significant difference in attenuation value between adenoma and PTC. Twenty-nine cases (76.3%) of goiter manifested mixed type, 3 cases (3/5) of adenoma showed decreased type, 6 cases (6/6) of thyroiditis showed increased type, and 55 cases (93.2%) of PTC showed decreased type attenuation. The sensitivity, specificity for thyroid carcinoma by dual-phase CT were 94.9% and 80.4% respectively. The overall diagnostic accuracy for thyroid lesions by dual-phase CT was 87.8%.

CONCLUSIONSThe performance of dual-phase helical CT is related to the pathological structure of the lesions. The analysis of enhancement patterns by using dual-phase helical CT will be helpful in the differential diagnosis of thyroid lesions.

Adolescent ; Adult ; Aged ; Carcinoma ; diagnostic imaging ; pathology ; Carcinoma, Papillary ; Female ; Goiter, Nodular ; diagnostic imaging ; pathology ; Humans ; Male ; Middle Aged ; Thyroid Gland ; diagnostic imaging ; pathology ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; Thyroiditis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo analyze the clinical and ultrasonographic imaging features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

METHODSTwelve patients with IPMN underwent surgery between May 2005 and December 2008, including 4 (33.3%) with adenoma and 8 (66.7%) with adenocarcinoma. IPMN was classified preoperatively into 3 types based on sonographic findings of different sites: main duct, branch duct, and combined type. All clinical presentations and ultrasonographic findings of those patients were reviewed and the correlation between ultrasonographic findings and histopathological results was analyzed.

RESULTSThere were 9 men and 3 women with a mean age of 60.1 +/- 9.6 years (range, 32-73). Of all the 12 patients with IPMN, 9 (75.0%) had experienced some symptoms of epigastric discomfort and/or pain as well as backache; 7 cases were with medical history of acute pancreatitis, 5 cases with diabetes, 4 cases with elevated CA19-9, and 2 cases with steatorrhea. All lesions of IPMN have been revealed by transabdominal ultrasonography. The mean diameters of the lesions were 1.4 +/- 0.8 cm (range, 0.5-2.0) and 6.3 +/- 6.0 cm (range, 2.0-20.0) in adenomas and adenocarcinomas, respectively. And the mean diameters of the main duct in adenomas and adenocarcinomas were 1.0 +/- 0.8 cm and 1.6 +/- 1.0 cm, respectively. Among the 4 adnomas, 3 (75.0%) cases were classified as branch type based on sonographic findings, and 2 were demonstrated as mural nodules in which no color signals was detected. Among the 8 adenocarcinomas, 5 (62.5%) cases were classified as main duct type, and 3 (37.5%) as combined type. In 7 of the 8 adenocarcinomas, mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected.

CONCLUSIONSTransabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic ducts. Some characteristics should be noticed as suggesting the possibility of malignancy: clinical symptoms of pancreatic insufficiency, large tumor size, and mural nodules with color Doppler flow signals. Transabdominal ultrasonography could be a useful tool to help diagnose and make appropriate management of IPMN.

Adenocarcinoma, Mucinous ; diagnostic imaging ; Adult ; Aged ; Carcinoma, Pancreatic Ductal ; diagnostic imaging ; Carcinoma, Papillary ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Cyst ; diagnostic imaging ; Pancreatic Neoplasms ; diagnostic imaging ; Ultrasonography